Social Security Administration (SSA) Disability Determinations

The Social Security Administration (SSA) makes determinations of blindness and disability as part of the eligibility determination for RSDI Retirement, Survivors, and Disability Insurance. A program operated by the Social Security Administration that provides a monthly income to retired people, survivors or dependents of insured people, and people with disabilities. or SSI Supplemental Security Income. A program based on financial need operated by the Social Security Administration that provides monthly income to low income people who are age 65 or older, blind or disabled. benefits.

Applying for SSA Benefits.

Denials and Appeals.

When SSA Benefits End.

Related Topics.

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Applying for SSA Benefits

All Minnesota Health Care Program clients must apply for other benefits that could increase their net income or help pay their medical expenses. The requirement to apply for other benefits pertains to benefits from SSA as well as other agencies, and is separate from the disability certification requirement for an MA basis of eligibility.

However, people who are certified disabled by SSA while applying for RSDI or SSI benefits also meet the disabled basis of eligibility requirement.

Disabled clients not receiving SSA benefits must:

l  Apply if they appear eligible, or

l  Appeal if their RSDI and SSI benefits are terminated or denied based on a finding that they are not sufficiently disabled.

For more information about the process of referring someone to apply for SSA benefits, see Social Security Administration (SSA) Benefits.

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Denials and Appeals

If the State Medical Review Team (SMRT) A unit at DHS that determines disability in consultation with medical professionals appointed by the commissioner. certifies disability while waiting for the SSA determination and SSA denies disability, continue MA eligibility with a disabled basis pending the outcome of the appeal to SSA.

l  The disabled basis may be continued until SSA has denied two appeals of the denial of the initial application.

l  If SSA denies the second appeal, provide timely notice and close MA unless another basis of eligibility exists.

Note:  Applicants or enrollees who have been denied SSA disability certification based solely on having earnings above the Substantial Gainful Activity (SGA) A level of work activity and earnings, defined by the Social Security Administration. amount can still qualify for MA-EPD Medical Assistance for Employed Persons with Disabilities. Program which provides MA coverage to certain employed disabled people who would not otherwise be eligible. and should be referred to SMRT. They are not required to appeal the SSA denial.

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When SSA Benefits End

If the SSA benefits of an MA enrollee with a disabled or blind basis of eligibility end due to earnings above the SGA level (or for other reasons not related to disability), make a referral to SMRT for a disability determination. This includes noncitizens who lose SSI eligibility after they've been in the U.S. for seven years. Leave MA open while the SMRT determination is pending.

In some cases, even though SSA benefits end, the enrollee is still considered to have a disabled basis of eligibility, and no SMRT referral is needed. This includes:

l  SSI recipients who gain 1619(a) and 1619(b) Provisions of the Social Security Act which allow certain employed people who would otherwise be ineligible to retain SSI status. The Social Security Administration certifies people for 1619(a) and 1619(b) eligibility. People with 1619(a) or 1619(b) status retain their MA eligibility under the SSI-related category if they received MA the month before certification for 1619(a) or 1619(b). status, and

l  People enrolled in Medicare A federal health insurance program for people who are age 65 or older, disabled, blind, or have permanent kidney failure. who lose RSDI benefits due to earning more than the SGA level. They are eligible for the Medicare Extension A period of extended Medicare eligibility for some disabled people who lost their RSDI benefit because they earn more than the Substantial Gainful Activity (SGA) level..

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Related Topics

For more information, see:

SMRT Disability Determinations.

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